Women with pre-eclampsia face a heightened risk of subsequent kidney disease within the first postpartum year when compared with those whose pregnancies are complicated by gestational hypertension, as shown in a retrospective study.
In a US cohort of 3.4 million in-hospital deliveries complicated by a new onset hypertensive disease of pregnancy, the rates of hospital readmission for acute or chronic kidney disease within 1 year of delivery were 38 per 100,000 person-months among those with gestational hypertension, 63 per 100,000 person-months among those with pre-eclampsia without severe features, and 102 per 100,000 person-months among those with pre-eclampsia with severe features. [Am J Kidney Dis 2026;88:556-564]
Compared with gestational hypertension, pre-eclampsia without severe features was associated with a risk increase of 55 percent for any kidney disease (adjusted hazard ratio [aHR], 1.55, 95 percent confidence interval [CI], 1.41–1.71), 49 percent for acute kidney injury (AKI; aHR, 1.49, 95 percent CI, 1.31–1.6), and more than twofold for chronic kidney disease (CKD; aHR, 2.31, 95 percent CI, 1.70–3.13).
Pre-eclampsia with severe features was associated with even greater risks of any kidney disease (aHR, 2.44, 95 percent CI, 2.23–2.68), AKI (aHR, 2.57, 95 percent CI, 2.30–2.87), and CKD (aHR, 6.03, 95 percent CI, 4.54–8.01).
“The hazard of readmission for AKI and CKD among individuals with pre-eclampsia, with and without severe features, was highest within the first 30 days after delivery and remained elevated across subsequent postpartum intervals throughout the calendar year,” the investigators noted.
Practical implications
The findings suggest that “although gestational hypertension and pre-eclampsia without severe features are managed identically in terms of foetal and maternal monitoring and timing of delivery, urine protein tests may be warranted in the postpartum period for patients with a hypertensive disorder in pregnancy and proteinuria to risk-stratify those at risk for CKD,” the investigators said.
Currently, the American College of Obstetrics and Gynecology and the American Heart Association have no specific guidelines for kidney assessment. In contrast, the National Institute for Health and Care Excellence in the UK recommends that individuals who had pre-eclampsia and still have proteinuria (via a urinary dipstick) at 6 to 8 weeks postpartum undergo a follow-up assessment at 3 months to evaluate kidney function. [Obstet Gynecol 2020;135:e237-e260; Hypertension 2022;79:e21-e41; https://www.nice.org.uk/guidance/ng133]
“Previous studies have shown that proteinuria level is a valuable risk-stratification tool in the post-AKI period in non-pregnant patients. Further studies are needed to determine the direct impact of persistent proteinuria on the development of future kidney disease,” the investigators said. [JAMA Intern Med 2020;180:402-410]
For the study, the investigators used data from the Nationwide Readmission Database 2010 and 2020. A total of 3,425,221 women with singleton pregnancies who had a new onset gestational hypertension, pre-eclampsia without severe features, or pre-eclampsia with severe features were included.
The study had several limitations, including those inherent to large-scale database research. There were no data on proteinuria or creatinine and other potential drivers of kidney disease, including race and ethnicity and BMI.